User:W.nguyen, Future UCSF PharmD/sandbox

Required Citation

 * 1) Canevelli, Marco; Valletta, Martina; Trebbastoni, Alessandro; Sarli, Giuseppe; D’Antonio, Fabrizia; Tariciotti, Leonardo; de Lena, Carlo; Bruno, Giuseppe (2016-12-27). "Sundowning in Dementia: Clinical Relevance, Pathophysiological Determinants, and Therapeutic Approaches". Frontiers in Medicine. 3: 73. doi:10.3389/fmed.2016.00073. ISSN 2296-858X. PMC 5187352. PMID 28083535.
 * 2) Gnanasekaran G (June 2016). ""Sundowning" as a biological phenomenon: current understandings and future directions: an update". Aging Clinical and Experimental Research. 28 (3): 383–92. doi:10.1007/s40520-015-0431-3. PMID 26243434. S2CID 41480208.
 * 3) Sundowning syndrome in aging and dementia: Research in mouse models". Experimental Neurology. 243: 67–73. 2013-05-01. doi:10.1016/j.expneurol.2012.05.005. ISSN 0014-4886.
 * 4) Bachman D, Rabins P (2006-01-12). ""Sundowning" and other temporally associated agitation states in dementia patients". Annual Review of Medicine. 57 (1): 499–511. doi:10.1146/annurev.med.57.071604.141451. PMID 16409163.
 * 5) Ferrazzoli, Davide; Sica, Francesco; Sancesario, Giuseppe (June 2013). "Sundowning syndrome: a possible marker of frailty in Alzheimer's disease?". CNS & neurological disorders drug targets. 12 (4): 525–528. doi:10.2174/18715273113129990065. ISSN 1996-3181. PMID 23574165.
 * 6) Staedt J, Stoppe G (June 2005). "Treatment of rest-activity disorders in dementia and special focus on sundowning". International Journal of Geriatric Psychiatry. 20 (6): 507–11. doi:10.1002/gps.1307. PMID 15920710. S2CID 8941229.
 * 7) Carter, Bethany; Justin, Hannah S.; Gulick, Danielle; Gamsby, Joshua J. (2021-03-26). "The Molecular Clock and Neurodegenerative Disease: A Stressful Time". Frontiers in Molecular Biosciences. 8. doi:10.3389/fmolb.2021.644747. ISSN 2296-889X. PMC 8056266. PMID 33889597.

Future Directions
There are several pathways in the pipeline for researchers seeking therapeutic options for sundowning syndrome.


 * NADH cytochrome C reductase is an enzyme involved in the synthesis of neuron energy. Decreased physiologic reserve (stress, hypometabolism, oxidative damage) in the elderly can lead to a decrease in neuron energy production and an increase in neuron damage.
 * Thioredoxin reductase is an antioxidant that neutralizes oxidative free radicals that can cause cell death. The brain is vulnerable to oxidative free radicals because it receives 20% of the human body's oxygen supply. Finding a way to maintain the thioredoxin reductase pathway can decrease plaque formation and SCN degeneration.
 * Inflammatory stress in mouse models can provide a pathway for studying neurodegeneration. It is hypothesized that neurodegeneration has a relationship with inflammatory cytokines such as IL-1β. The role of cytokines in sundowning can improve our understanding of the pathology.

Risk Factors
Elderly patients often experience multi comorbidities that may contribute to the phenomenon of sundowning syndrome through neurodegeneration.


 * Neurological disorders: Alzheimer's disease, Parkinson's disease, fronto-temporal dementia, subcortical dementia
 * Neurobehavioral disorders: Anxiety and Depression
 * Cerebrovascular disease risk factors: Hypertension, Smoking, Obesity